31 March 2015 - - As millions of Americans entered the health care system for the first time through the Affordable Care Act, analysts warned of a coming strain on the health care system. One prediction was overcrowded offices, resulting in longer waits for patient care. Quite the opposite has happened, according to new research from US health care company Vitals. Vitals found that, instead of going up, wait times are actually coming down. According to the 6th Annual Vitals Index, the national average for wait times dropped to 19 minutes and 16 seconds, a full one-minute shorter than the 2014 wait time average. Several factors could be contributing to the decrease. Alternative care facilities, like urgent care centers and retail clinics, could be taking the burden off primary care doctors. Physician extenders, like nurse practitioners and physician assistants, may also be easing doctor caseloads. Even the rise of concierge medicine can be diverting patients from traditional group practice care. In fact, wait times for primary care doctors, the doctors Americans see the most, were generally down over one minute (1minute, 11 seconds) in a year-over-year comparison. While wait times are decreasing overall, the study found wide variations by doctor specialty. Dentists (13minutes, 31 seconds) and plastic surgeons (15 minutes, 22 seconds), whose patients often pay out-of-pocket, have the shortest wait times out of the 61 types of specialists Vitals analyzed. Emergency doctors (24minutes, 41 seconds) and pain management specialists (24minutes, 52 seconds) had some of the longest wait times. Beyond the type of doctor, where one sees the doctor matters, too. Out of the 50 largest cities across the US, Portland edged out Seattle for the shortest wait time at 15 minutes, 48 seconds in 2015. Minneapolis, Seattle, Milwaukee and Omaha were also in the top 5. For the fourth year in a row, the longest wait time was reported in El Paso at 26 minutes, 21 seconds. Memphis, Miami, New York and Las Vegas were also at the bottom of the ranking. For states, New Hampshire led the nation with the shortest wait time at 15 minutes, 4 seconds. The remaining top states with shortest physician wait times include Wisconsin, Maine, Minnesota and Vermont. Alabama edged out Mississippi this year as the state with the longest wait, averaging 23 minutes, 25 seconds. Mississippi, Louisiana, Arkansas and Tennessee were also in the bottom five. Vitals' annual Physician Wait Time Report, now in its sixth year, is compiled from patient-reported wait times. The Vitals Index is designed to provide information about the current state of the doctor-patient relationship.